Although not intended to
address patient billing complaints, health care compliance programs can
sometimes provide an effective mechanism to resolve such complaints.

The Office of Inspector General
(OIG) of the Department of Health and Human Services (HHS) has long promoted
voluntary compliance programs for the health care industry. OIG issued
its compliance program guidance for hospitals in February 1998. Compliance programs
promote ethical and lawful corporate conduct. Specifically, compliance programs
promote prevention, detection, and resolution of instances of conduct that do
not conform to federal and state law, health care program requirements, and
the hospital’s ethical and business policies. Under federal sentencing guidelines,
the Department of Justice and OIG look to see if an entity guilty of misconduct
has exerted reasonable efforts to avoid and detect any misbehavior that occurs
within their operations. The existence of an effective compliance program may
determine the level of sanctions, penalties and exclusions that will be imposed
on the health care provider. See The Office of the Inspector General's Compliance
Program Guidance for Hospitals at Fraud/980219OIGCompliance.html.

A typical compliance program’s
Standards of Conduct may provide in pertinent part:

We are committed to fair
and accurate billing that is in accordance with all Federal and state laws.

We will not knowingly submit
for payment or reimbursement a claim we know to be false.

We will respond in a direct,
timely and honest manner to all questions and complaints related to a patient’s
bill.

I entered a hospital in 2001
for minor surgery not covered by insurance. Prior to the surgery
I was quoted a fee of $700 for hospital services, and as required prepaid
such amount in full. I received a bill for an additional $3980.42, and
despite repeated and time-consuming attempts to resolve the billing error,
I was unable to do so. Additionally, I was quoted a fee of $550 for anesthesiology
services to be performed by an exclusive contractor for the hospital, which
was also prepaid in full. My receipt showed a zero balance. I received
a bill for an additional $115. When I disputed the additional charge, it
was referred to a collection agency, which threatened to report the bill
to credit reporting agencies. Although the anesthesiologist was an “independent
contractor” it seemed possible that the hospital had contractual undertakings
requiring them to adhere to the hospital’s Standards of Conduct.

Both the initial billings
and the failure to resolve them in a “timely” manner were clearly in violation
of the hospital’s Standards of Conduct, so I sought the compliance director’s
help in rectifying these violations and insuring that such conduct does
not occur in the future. After a review by the compliance director, the
hospital quickly agreed to drop the additional charges. The anesthesiology
contractor also agreed that its billing was in error. But these sorts
of problems are not supposed to happen to health care lawyers and professors!

Resort to a compliance program complaint
should be considered a possible “intermediate” method of resolving a billing
dispute—somewhere between trying to resolve the issue with the provider’s billing
department and the last resort of a lawsuit. Usually, resolving a patient
billing error is no different than dealing with any other consumer billing problem
and the same advice applies. First, keep a copy of every bill and other
correspondence related to the matter. Keep an accurate record of any telephone
attempts to resolve the matter, including the name and title of each person
you speak with as well as notes of your conversation. If the dispute involves
a significantly tardy bill, a recent Texas law may offer some help. Generally,
Texas health care providers are required to bill patients or insurers within
10 months from the date of service. Failure to bill in a timely manner
may absolve the patient of responsibility for the bill. See Shifting Responsibility
for Health Care Billing Mistakes in Texas at HealthPolicy/981125Shifting.html.